Transcript Overview of Palliative Care - Scioto County Medical Society

Overview of
Palliative Care
Suzann Bonzo, MD
The Greatest Barrier
 The
greatest barrier to end of life care is
Clinicians

Due to the lack of confidence in their ability
to talk about EOL issues and poor delivery
of “bad news”
End of Life
 The
last 18 months of life often encompass
the longest and most frequent
hospitalizations and the most cost.
 During the last 18 months of life, studies
show that patients and families desire to
stay home with less aggressive
interventions.
Today
 Today
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
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
is to help us:
Understand why Palliative Care originated
Be able to discuss the benefits of Palliative
Care
Be aware of barriers to Palliative Care
Understand challenges of Palliative Care
Palliative Care in Hospice
 Initially
Hospice and Palliative Care were
essentially the same
 Need to think of a continuum of care
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
Longer period of time
Many life limiting diseases
End of life is not clearly defined
Components of
High Quality Palliative Care
 Pain
will be adequately treated
 Avoid inappropriate prolongation of life
 Obtain a sense of control
 Relieving burden
 Strengthen relationships with loved ones
National Consensus Project

Quality Palliative Care developed guidelines
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Structure and process of care
Physical aspects
Psychological and psychiatric aspects
Social aspects
Spiritual, religious, and existential aspects
Cultural aspects
Care of the imminently dying patient
Ethical and legal aspects
Preferred Practices for
Palliative and Hospice Care
 Handout
Make up of the Palliative Care
Team
 The
National Consensus Project for Quality
Palliative Care recommends that the
interdisciplinary palliative care team
include palliative care professionals with
the appropriate patient- populationspecific education, credentialing, and
experience and ability to meet the
physical, psychological, social, and
spiritual needs of both patient and family.
Referrals from PCP to Hospice
 PCP
works directly with Interdisciplinary
team of RN, SW, Counselors
 Manage symptoms and medications
 Certification for PC/ Hospice
 Sign death certificates
Palliative Care Involves:
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Trust
Overcoming barriers to care and symptom relief
Compassionate communication
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Accurate prognostic information
Maintaining hope
Eliciting symptoms
Decisions regarding curative and palliative
treatments
Dealing with varying emotions
Educating when unrealistic goals are being sought
Most Common Diagnoses
Distribution of Diagnoses in Hospice Care, 2010
2% 1% 2% 1%
4%
Cancer (36%)
0%
Heart Disease (14%)
Debility, unspecified (13%)
9%
38%
Dementia (including Alzheimer's disease)
(13%)
Lung disease (8%)
Stroke or coma (4%)
14%
Kidney Disease (2%)
Motor neuron diseases (non-ALS) (1%)
Liver disease (2%)
14%
15%
Amyotrophic lateral sclerosis (0.4%)
HIV/AIDS (0.3%)
Most Common Diagnoses
Distribution of Diagnoses in Hospice Care, SOMC
2/2015-2/29/16
Chronic Airway Obstruction (33%)
9%
9%
33%
Senile Degeneration of Brain (26%)
Alzheimer's Disease (23%)
23%
Debility (9%)
26%
Lung Cancer (9%)
Benefits of
Palliative Care at the End of Life
 Quality
of life
 Satisfaction with care
 End of life outcome
 Family and care-giver perceptions of end
of life care
 Survival advantage (especially in CHF)
 Cost-effectiveness
Challenges in Palliative Care
 Lack
of trained professionals
 Reimbursement issues
 Difficulty in prognosis
 Knowledge and attitude of patients,
families, and healthcare providers
Comparison:
Palliative Care and Hospice
 Handout
Admission Criteria
 Handout
 Palliative
Care Appropriate Screening Tool
Communication in the
End of Life Setting
 One
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of the most important skills for providers:
Disease process
Prognosis
Likely symptoms and how they will be managed
Treatment options and effect on quality of life and
length of life
Answer difficult questions regarding the dying
process
Advance care planning
Timing of
Palliative Care Discussion
 Earlier
than later